Cryotherapy, cold water bathing

Hutan

Hutan

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Immersion in cold water has sometimes been mentioned as a possible treatment for many things and specifically ME/CFS in social media. There are also the traditions of Scandinavian countries and others of alternating sauna with cold water dips.

I thought it would be useful to look at the evidence and hear about any personal experiences with this.
 
There is this series from mainly Polish researchers, with Kujawski as the first author, and including Pawel Zalewski and Julia Newton and with senior author Joanna Slomko.

Changes in the Allostatic Response to Whole-Body Cryotherapy and Static-Stretching Exercises in CFS Patients vs. Healthy Individuals, 2021, Kujawski

Combination of whole body cryotherapy with static stretching ... reduces fatigue and improves functioning of the [ANS] in CFS, 2022, Kujawski et al

Effects of whole-body cryotherapy and static stretching are maintained 4 weeks after treatment in most patients with CFS 2023 Kujawski et al

Whole-body cryotherapy (WBC) is based on repeated sessions of very brief exposure to an extremely low temperature delivered in a chamber. The temperature in the chamber might range from −100 °C to −130 °C and exposure time lasts up to 3 min
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Karl Morten's Oxford lab seems to be raising money to undertake a cryotherapy study - mentioned on the Morten thread

Detail from the Morten website:
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Low cold temperature (Cryotherapy) project​

This project is part of a long-term collaboration with Professor Pawel Zalewski (Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun). Pawel’s group have run and published a series of excellent papers investigating the physiology and impact of treatments in ME/CFS. In order to identify “candidate” causal elements in a condition like ME/CFS you really need to observe changes in patient’s symptoms which correlate with a disease associated variable. Just comparing ME/CFS patients with a control group or other similar conditions at a single time point will not identify causal elements and just give you an association. ME/CFS and similar conditions such as fibromyalgia and Long Covid are at best linked to associated markers.


Our Oxford based studies are identifying lots of associations (Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome with Partial Least Squares Discriminant Analysis: Relevance of Blood Extracellular Vesicles | Medicine (frontiersin.org). How do we move from associations to identify causal elements which could lead us to novel treatment targets? Pawel’s whole-body cryotherapy (WBC) project is an extremely valuable source of information. Both patients and controls enjoyed participating in the cryotherapy programme which involved 10 exposures over 10 days to short bursts of extreme cold (Changes in the Allostatic Response to Whole-Body Cryotherapy and Static-Stretching Exercises in Chronic Fatigue Syndrome Patients vs. Healthy Individuals (mdpi.com) . Unlike a Structured Exercise programme (SEP) (Prediction of Discontinuation of Structured Exercise Programme in Chronic Fatigue Syndrome Patients (mdpi.com) (Relationship between Cardiopulmonary, Mitochondrial and Autonomic Nervous System Function Improvement after an Individualised Activity Programme upon Chronic Fatigue Syndrome Patients (mdpi.com) all patients and controls completed the 10 day programme. Some patients showed symptom improvement for 3 months with symptoms reverting to baseline levels after 12 months (unpublished data). Although not a cure, cryotherapy could offer (i) short term treatment and more importantly (ii) give us unique insights into the potential causal elements in the disease. Which biological variable changes when patients improve? Do these same variables go back to disease levels when patients get worse? Are these the same for all patients?


Metabolomics is a relatively new technique which looks at all the chemicals in a blood sample. Cells are removed and we study the chemicals which originate from unknown organs in the body. We are looking for a signature which could (i) tell us if someone has ME/CFS or (ii) tell us which chemicals link to increased or decreased symptoms. The whole-body cryotherapy cohort of thirty-two ME/CFS patients meeting the Fukuda criteria for ME/CFS have also had a wide range of clinical test at each time point. The gut microbiome in the same subjects has already been assessed at each time point. This new study will investigate the plasma metabolomics profile working with the National Phenome centre in UK (Home - National Phenome Centre). Both targeted and untargeted profiling will be used. Targeting identifies known chemical signatures and allow us to compare to previous studies. Untargeted is more compound discovery and will look for differences in any chemical in the sample. Approach to work on untargeted molecules is more challenging but has the potential to unearth “golden” molecules in the sample. These “golden” molecules if linked to improvements or worsening of symptoms can be identified and explored as potential therapeutic targets.


Speed and cost of the study: Our previous work with metabolomics although identifying interesting insights into the condition due to lack of resources has been slow. Jamie Strong in the Morten group has been leading the research efforts and has done a marvellous job. Jamie came into the group with no research experience and continues to suffer with ME/CFS. He supports the team in translating the experience of ME/CFS symptoms to setting an approach for research into the molecular underpinnings of this debilitating disease. Although Jamie’s research skills have excelled substantially, Jamie still has ME/CFS and for the last 18 months has been taking on the part-time Oxford University MSc in Medical statistics course. Although Jamie has little time now we are keen to get him back in the future! The National Phenome Centre is an MRC NIHR funded resource which will allow us to have a much faster turn-around time for our samples. Our data will be back in 6 months which will allow us to work with the data and integrate it with the other data generated on the same samples and patients. This is a much faster approach than our poorly funded metabolomics studies which after several years are just coming to the paper drafting stage.


Total cost of the study

£38,500
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“The whole-body cryotherapy cohort of thirty-two ME/CFS patients meeting the Fukuda criteria for ME/CFS have also had a wide range of clinical test at each time point.”

The Fukuda criteria is for CFS, not ME/CFS as we now understand it.
 
I cannot speak for anyone else but cryotherapy would be impossible for me because of my illness diagnosed as ME CFIDS but I can and do use pyrotherapy.

Cryotherapy is impossible for me for two reasons, the first is that I have been susceptible to recurring viruses which are triggered by chilling. The second is that I suffer from recurring viruses which occur in an incessant cycle whether I am chilled or not, interacting with my immune system and at certain phases of the immune response I am hypersensitive to cold sensations and can experience rigors which are an aspect of autonomic responses and are most unpleasant.

Cryotherapy therefore would be inappropriate for the kind of ME CFIDS I endure. Once again we are talking about subtypes and our collective failure to distinguish them. Maybe some could benefit from cryotherapy but suitability needs to be the frst assessment made for patients being considered for this kind of therapy and needs to be discussed as part of the scientific process not fudged and brushed under the carpet.
 
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Blending messages from a couple of threads:

Jonathan Edwards said:
But I would not totally discount some physical procedure - even something like cold water immersion! That might seem crazy but if we take neuroimmune signalling seriously, and maybe we should, and the nervous system really does regulate T cells, then an overwhelming neural reflex might do something spectacular. I always remember the fact that if you have an inflamed thumb from hitting it with a fourteen pound hammer by mistake (I have tested this) much the best way to remove the pain is ice, not painkillers.
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Sasha said:
Back in the 90s (?), after years in bed and having to have my food cut up for me, I had a spectacular improvement after several weeks of a cold-water therapy that consisted of immersing yourself in an increasingly cold bath for longer and longer. I'd read about it in the Daily Mail :sick: - a Professor Kakkar (this guy, I think) had published a protocol for readers with ME to follow and IIRC was claiming to have got results and was promising a clinical trial (which never appeared, AFAIK).

I went from bedbound to walking four miles a day, pretty quickly, without slowly grading up. Then seemed to catch another bug and the improvement disappeared and never came back, even though I persisted with the horrible baths for ages.
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Jonathan Edwards said:
Yes, I think that was what triggered my example!
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Sasha said:
I would be worried about safety at my age now of jumping (well, lurching) into a cold bath in case of a heart attack. I wonder what the safety profile of cryotherapy is for older people in particular.
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Lot’s of people of all ages bathe outside in the winter in Norway. I’ve never heard of anything going wrong. But I wouldn’t extrapolate general advice from those anecdotes.
 
Utsikt said:
Lot’s of people of all ages bathe outside in the winter in Norway. I’ve never heard of anything going wrong. But I wouldn’t extrapolate general advice from those anecdotes.
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I've been wondering how cold-water bathing fits into this. Famously in England a load of people go swimming in the pond on Hampstead Heath on Christmas Day. I wonder if the people who go are self-screening somehow, or just hoping for the best, or if people do get heart attacks but it doesn't get reported or noticed much.
 
Sasha said:
I've been wondering how cold-water bathing fits into this. Famously in England a load of people go swimming in the pond on Hampstead Heath on Christmas Day. I wonder if the people who go are self-screening somehow, or just hoping for the best, or if people do get heart attacks but it doesn't get reported or noticed much.
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Peter T said:
Google AI recons 400 people die every year in the UK due to cold water immersion, with cold shock being a significant contributing factor.
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Apparently the American Heart Association warns against it:
www.heart.org

You're not a polar bear: The plunge into cold water comes with risks

Some people believe cold water swims, including the popular "polar bear plunges," have health benefits, but there's little evidence to support that notion. In fact, the practice can be dangerous.
www.heart.org www.heart.org
 
I've tried cryotherapy in the form of the Irish Sea.

I cannot recommend it to anyone with low blood pressure.

Sasha said:
Famously in England a load of people go swimming in the pond on Hampstead Heath on Christmas Day.
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I've a friend who's been a regular at Hampstead Ponds for many years, who says quite lot of them also swim on days when the BBC isn't there to film them. They're used to cold water.
 
Have cold allergy and during last episode struggled with breathing and felt generally very unwell, so guess it's out of the question to even try.

But a specialist in infectious diseases mentioned it as something perhaps worth trying for my ME - 30 years ago. He didn't have any special knowledge about ME though. Still doesn't come to think of it as he's very enthusiastic about LP.

Charles Darwin swore to it and had an outside cold shower.
 
Kitty said:
I've a friend who's been a regular at Hampstead Ponds for many years, who says quite lot of them also swim on days when the BBC isn't there to film them. They're used to cold water.
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I wonder if gradually getting used to cold water is important for safety (for example, if you start outdoor bathing in the summer and keep going as the water gets colder), but might mean that there would be less efficacy as an intervention for ME/CFS if it operates by being a big fat shock to the system (if it has any efficacy at all).
 
Sasha said:
I wonder if gradually getting used to cold water is important for safety
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It is. People new to open water swimming groups often start to build tolerance before even they start going, and even when they do they may not fully immerse themselves first time. They learn how to enter cold water (gradually) and how long to stay in it at the beginning (seconds). And that's assuming they passed the health screening in the first place.

To be fair, cryotherapy is a lot safer. Entering cold air isn't such a shock as entering cold water, and you don't get the diving reflex coming in either. But what's the theoretical basis for thinking it would help? I suspect it's another type of distraction—people exposed to extreme cold for short periods in supportive settings often find it exhilarating. They feel good (or at least better than they did) for a while.
 
Kitty said:
It is. People new to open water swimming groups often start to build tolerance before even they start going, and even when they do they may not fully immerse themselves first time. They learn how to enter cold water (gradually) and how long to stay in it at the beginning (seconds). And that's assuming they passed the health screening in the first place.
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That's interesting that there is health screening! Is that where open-water bathing is happening in groups, and they have a system?
Kitty said:
To be fair, cryotherapy is a lot safer. Entering cold air isn't such a shock as entering cold water, and you don't get the diving reflex coming in either. But what's the theoretical basis for thinking it would help? I suspect it's another type of distraction—people exposed to extreme cold for short periods in supportive settings often find it exhilarating. They feel good (or at least better than they did) for a while.
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I haven't mugged up on mechanism yet but @Jonathan Edwards (where I quoted him upthread) said that 'an overwhelming neural reflex might do something spectacular' in relation to neuroimmune signalling, and the nervous system regulates T cells, which could be what we need if the theory is correct that he and Jo Cambridge and Jackie Cliff put forward in Qeios.

But @Jonathan Edwards, would that mean that you'd expect a possibly curative effect from a single big fat shock to the system? Rather than people needing a course of treatment?

I don't know that we even have many anecdotes to go off about PwME doing well after cold-water therapy, let alone papers on cold-therapy generally.
 
Jonathan Edwards said:
Probably yes, if you don't die of ventricular fibrillation.
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I'm wondering if that means that acclimatisation would be a bad idea, then, cure-wise. (Don't try this at home, folks!)

And yet of all the stuff that we hear about - LDN, vagal nerve stimulation, probiotics, Ampligen, the Lightning Process, you name it - we don't hear any PwME talking this approach up, based on personal experience. I wonder if that means it doesn't work, or that hardly anybody is trying it, or that everybody who tried it died...

The Curious Incident of the Anecdote in the Night-Time...
 
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